If your eating disorder care has been rejected for insurance coverage, you’re in the right place.
Nutrition counseling is protected by law for anyone with an eating disorder. When your insurance company tells you it is “not a covered benefit” or refuses to pay your dietitian, there is a good chance they are breaking the law, possibly without knowing it. It can be challenging to fight back, but it’s worth it for your health or for your child. Because we believe that nutrition counseling saves lives, we would like to do everything we can to help you.
On this page you will find sample appeal letters for different situations, instructions for filing an appeal and a report, other ways to get help, and authorization forms if you would like personal help contacting your insurance company.
Step 1: Keep Track of Everything
You can print this page to help you keep track of your calls, or it’s ok to write this same information in a notebook or in a document on your computer or phone.
Write down information about every single call, email and letter you receive or send to or from your insurance company. If you haven’t been keeping track, start now. This will give you a record to refer back to when you get conflicting information and will allow others who are helping you to get up to date without you having to repeat yourself. Continue keeping track throughout the entire process until the situation is completely resolved.
Step 2: Request Your Policy
There are two reasons it’s important to find out what your insurance policy says about eating disorder care.
1. The insurance company may not be following their own policies. Sadly this happens a lot and the good news is you can point it out to them using their own document.
2. The policy may illegally restrict eating disorder care. We have letters you can use below to explain why the plan is illegal.
Here are the steps to getting a copy of your insurance policy.
Step 3: Ask for a Case Manager
Call the customer service phone number on your insurance card and say this to the agent who answers:
“I have a complicated situation and I would like to be assigned a case manager who can help me.”
If the agent says, “I can help you,” say this:
“I need a case manager because I need a direct phone number where I can call the same person every time. Do you have a direct phone number I can call?”
If the agent doesn’t have a direct phone number, they are not the right person to help you. Ask again for a case manager, and if they can’t assign you one, ask to speak with their supervisor.
Once you have a case manager assigned, write down their name and direct phone number. Then explain to them the entire situation so far, including the calls you’ve made, the letters you’ve received, and the problems you’re still having.
There is no charge for getting a case manager from your insurance company and it can make a big difference in getting the care you need and cutting down on the frustration of explaining your situation over and over again.
Step 4: Appeal the Rejection
When your nutrition counseling visit is rejected (“denied”) by your insurance, you will receive either an “Explanation of Benefits” (EOB), a letter explaining the decision (a “denial letter”), or both.
If you only receive a phone call telling you your care isn’t covered, tell the person, “I need something in writing – either a letter or email – that states that my care will not be covered, that shows the reason for the decision, and that tells me where to file an appeal.”
Having either a paper or email document helps prove that your insurance is making mistakes.
Your next step is to look at your denial/rejection letter and find the reason your insurance won’t pay. Sometimes this is a two-letter code that is explained at the bottom of the page.
Some examples of reasons are Not a covered service, Not a covered service for this diagnosis, Exceeds visit limit, and there are others.
Choose the denial/rejection reason below and you will find a form letter that says why this reason is illegal.
Download the letter to your computer, then add in your personal information. Print and sign the letter, then send it to your insurance at the address listed on your denial/rejection letter. You may need to look at the back pages of the letter to find this address. If there is a place to submit online for emergencies, use that option.
Choose this letter if your insurance says it doesn’t have to pay for your care because your plan only covers a certain number of eating disorder care appointments and you’ve had more than that number:
Choose this letter if your insurance says it doesn’t have to pay for your care because your plan is “self-funded”:
Choose this letter if your insurance says it doesn’t have to pay for your care because your plan is “self-funded” AND it only covers a certain number of eating disorder care appointments and you’ve had more than that number:
Choose this letter if your insurance says it doesn’t have to pay for your care because your eating disorder care is “not a covered service” or your eating disorder is “not covered” by your plan:
Choose this letter if your insurance says it will pay for nutrition counseling with a general dietitian but not with an eating disorder specialist:
Choose this letter if your insurance says it will not pay for your eating disorder care because it is “not medically necessary” or if your insurance asks for a “medical necessity letter” or “evidence of medical necessity” in order to approve care. Note: This letter is for your dietitian or other provider to complete and return to the insurance company:
Step 5: Get Others Involved
Here are some options for where to turn for help:
- Your employer or your employer’s human resource department
- The person who chooses your insurance company has direct phone numbers to call and solve problems. Who is in charge of this at your workplace? Can you ask them for help?
- Tell the person, “I’m having trouble getting my (or my child’s) healthcare appointments covered by our insurance, even though they’re medically necessary. What information do you need in order to help me?”
- The Employee Benefits Security Administration (EBSA)
- If your insurance comes from your employer, and your employer is not the government, then most likely your insurance is regulated by EBSA, the Employee Benefits Security Association. Although this sounds intimidating, they are just people who want to help solve insurance problems.
- Fill out a complaint form at this website: https://www.askebsa.dol.gov/WebIntake/. Someone who can help will contact you.
- Contact Us Directly
If you are overwhelmed, getting frustrated by deadends, or for any reason would like personal help with your insurance rejection of your eating disorder care, please download and complete either the Adult or Parent/Guardian authorization form below and return to CARE@IFEDD.org.
Designated Authorized Representative Form for Insurance Assistance – AdultDownload
Designated Authorized Representative Form for Insurance Assistance – Parent or GuardianDownload - Your state’s Insurance Commissioner
- Search online for the name of your state and the words Insurance Commissioner Health Insurance.
- Look for a phone number, email address or online complaint form.
- Call or email and say, “I’d like to report a mental health parity violation. Can you please direct me to the right person.” (You will not be talking with the Insurance Commissioner, it will be someone in their office who is assigned to help with health insurance problems.)
- Once you reach the right person, tell them you are unable to get the healthcare you need due to unfair insurance practices and explain the details of your situation. Ask them to help you.
- Your Legislators
- The people who represent you in your state legislature and in the US Congress all have a “healthcare aide” or someone assigned to help with insurance problems.
- Search online using your zip code and the words Who is my state representative? Who is my US Representative? and Who is my Senator? to find contact information for that person’s office.
- Look for a phone number, email address or online complaint form.
- Call or email and say, “I need help with a health insurance problem. Can you please direct me to the right person.” (You will not be talking with your legislator, it will be someone in their office who is assigned to help.)
- Once you reach the right person, tell them you are unable to get the healthcare you need due to unfair insurance practices and explain the details of your situation. Ask them to help you.
- Other Regulatory Agencies
- Different agencies are in charge of different types of insurance plans. If your insurance is not through your employer, or if your employer is the government, use this list to find the right agency for your type of insurance. Then follow the steps above to ask for help.
A note about regulatory agencies:
Contacting regulators can sound scary, so here’s a pep talk.
Insurance companies have to answer to the government. But the government can only help if they know about your problem.
You Don’t Need to Be 100% Certain—That’s Why Oversight Exists
Even if your concern turns out to be a misunderstanding, raising it can:
- Highlight unclear policies
- Identify barriers to care
- Push regulators to improve enforcement
- Contribute to broader policy fixes
Many healthcare protections exist today because people spoke up when something didn’t seem right.
Concerned About Retaliation? Regulators Need to Hear That, Too
Speaking up can feel risky, especially for providers, employees, or patients who rely on their benefits. But if fear of retaliation is preventing reports, that itself is a red flag regulators should know about.
- Mention it when raising your issue. Agencies need to know if concerns aren’t being reported due to fear of consequences.
- Regulators can’t act on what they don’t know. If audits, network removal, or other pressures are deterring complaints, that signals a deeper problem.